Sudden and unexpected deaths in young competitive athletes are uncommon but highly visible events, which raise concern and ethical issues in both the lay public and medical community. Which is the best strategy to timely identify individuals with cardiac disease responsible for sudden death (primarily, HCM) is largely debated. Namely, the extent to which sophisticated testing, such as echocardiography, is needed is still undefined.
To address this question, we carried out an echocardiographic assessment of the structural cardiac diseases in a population of 4,450 athletes, initially judged free of cardiac disease and eligible for competition on the basis of pre participation screening with 12-lead ECG.
None of the 4,450 athletes showed evidence of HCM. Other cardiac abnormalities were detected in only 12 athletes, including myocarditis (n=4), mitral valve prolapse (n=3), Marfan's syndrome (n=2), aortic regurgitation with bicuspid valve (n=2), and arrhythmogenic right ventricular cardiomyopathy (n=1). In addition, 4 athletes were identified with borderline LV wall thickness (i.e., 13 mm) in the "gray-zone" between HCM and athlete's heart. In 2 of these athletes, subsequent genetic analysis or clinical changes over an average 8-year follow-up resulted, respectively, in a diagnosis of HCM.
In conclusion, the pre participation screening program including 12-lead ECG appears to be efficient in identifying young athletes with HCM, leading to their timely disqualification from competitive sports. These data also suggest that routine echocardiography is not an obligatory component of large population screening programs designed to identify young athletes with HCM.